<form method="POST" action="/checkoutBillingInfoFrame.jhtml?_DARGS=/checkoutBillingInfoFrame.jhtml" name="CheckoutBillingInformation">
<!-- <setvalue bean="CheckoutRegistrationHandler.submitSuccessURL" value="processShowRegistrationNextPage.jhtml"> -->
<table border="0" width="100%" cellpadding="0" cellspacing="0">
<tbody><tr>
<td align="center">
<!--Begin Top Content Table -->
<table width="800" border="0" align="center" cellpadding="0" cellspacing="0">
<tbody><tr><td height="8" colspan="2"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="8" height="8"></td></tr>
<tr>
<td>
<img src="https://www.peapod.com/c/WW/WWFDP.gif" border="0" alt="logo">
</td>
<td>
<div align="right">
<table border="0" cellpadding="0" cellspacing="0">
<tbody><tr>
<td  nowrap=""><a href="javascript:backToShopping('HIWYF1OFKGGQMCQBD0XCF3Q');">Return to Shopping</a></td>
<td >&nbsp;&nbsp;|&nbsp;&nbsp;</td>
<td  nowrap=""><a href="javascript:saveExit('HIWYF1OFKGGQMCQBD0XCF3Q');">Save &amp; Exit</a></td>
<td >&nbsp;&nbsp;|&nbsp;&nbsp;</td>
<td  nowrap=""><a href="javascript:myAccount('HIWYF1OFKGGQMCQBD0XCF3Q');" id="navLinkMyAccount">
My Account</a></td>
<td >&nbsp;&nbsp;|&nbsp;&nbsp;</td>
<td  nowrap=""><a href="javascript:help('HIWYF1OFKGGQMCQBD0XCF3Q');">Help</a></td>
<td >&nbsp;&nbsp;|&nbsp;&nbsp;</td>
<td  nowrap=""><a href="javascript:quickGuide('HIWYF1OFKGGQMCQBD0XCF3Q');">Top FAQs</a></td>
</tr>
</tbody></table>
</div>
</td>
<td align="right" nowrap="nowrap">
</td>
</tr>
<tr>
<td height="17" colspan="2"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="17" height="17"></td>
</tr>
</tbody></table>
<!--End Top Content Table -->
</td>
</tr>
<tr>
<td align="center">
<table width="713" border="0" align="center" cellpadding="0" cellspacing="0">
<tbody><tr>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="129" height="38" alt=""></td>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="82" height="38" alt=""></td>
<td><img src="https://www.peapod.com/c/C9/C97QV.gif" width="102" height="38" title="Enter Billing Information"></td>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="177" height="38" alt=""></td>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="113" height="38" alt=""></td>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="110" height="38" alt=""></td>
</tr>
<tr>
<td><p><img src="https://www.peapod.com/c/ZC/ZCUFR.gif" width="129" height="27" alt="" border="0"></p></td>
<td><img src="https://www.peapod.com/c/UJ/UJMGS.gif" alt=""></td>
<td><img src="https://www.peapod.com/c/YB/YB2VO.gif" alt=""></td>
<td><img src="https://www.peapod.com/c/VH/VHS4Q.gif" alt=""></td>
<td><img src="https://www.peapod.com/c/Y3/Y3U2O.gif" alt=""></td>
<td><img src="https://www.peapod.com/c/WH/WHMKY.gif" alt=""></td>
</tr>
<tr>
<td colspan="6"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="15" height="15"></td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td>
<table cellpadding="5" width="100%" cellspacing="0" border="0">
<tbody><tr>
<td align="center">
<table width="713" border="0" align="center" cellpadding="0" cellspacing="0">
<tbody><tr>
<td width="11" height="9"><img src="https://www.peapod.com/c/C1/C1QGC.gif" width="11" height="9"></td>
<td height="9"><img src="https://www.peapod.com/c/KW/KWOGQ.gif" width="691" height="9"></td>
<td width="11" height="9" id="RightBorder"><img src="https://www.peapod.com/c/CK/CKBW7.gif" width="11" height="9"></td>
</tr>
<tr>
<td valign="top" background="https://www.peapod.com/c/HF/HFM6V.gif"><img src="https://www.peapod.com/c/HF/HFM6V.gif" width="11" height="61"></td>
<td valign="top" bgcolor="#FFFFFF" width="691">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody><tr>
<td colspan="5" valign="top"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="10" height="10"></td>
</tr>
<tr>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="0" height="0"></td>
<td colspan="3" >Required fields shown in <b>bold</b></td>
<td><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="0" height="0"></td>
</tr>
<tr>
<td width="15" valign="top"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="15" height="15"></td>
<td valign="top">
<table width="420" border="0" cellspacing="5" cellpadding="0">
<tbody><tr>
<td colspan="3">
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white">
<tbody><tr valign="top">
<td >
<div id="TitleBox" >
<img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="5" height="5" border="0" bgcolor="white" name="imgTitle">
</div>Billing Information
</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td colspan="3" align="right" >
<input type="checkbox" checked="" onclick="sameAddress('false');">My billing address and delivery address are the same.</td>
</tr>
<tr>
<td colspan="3">&nbsp;</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Title:</div></td>
<td colspan="2">
<input maxlength="3" name="billTitle" size="3" type="TEXT" value="Ms."  readonly=""><input type="hidden" name="_D:billTitle" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">First Name:</div></td>
<td colspan="2">
<table border="0" bgcolor="white" cellpadding="0" cellspacing="0" width="100%">
<tbody><tr>
<td valign="middle">
<input maxlength="20" name="billFirstName" size="20" type="TEXT" value="Shorty"  readonly=""><input type="hidden" name="_D:billFirstName" value=" ">
</td>
<td  nowrap="">&nbsp;&nbsp;Middle Initial:&nbsp;</td>
<td>
<span ></span>
</td>
<td width="100%">&nbsp;</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Last Name:</div></td>
<td colspan="2">
<input maxlength="30" name="billLastName" size="30" type="TEXT" value="Nge"  readonly=""><input type="hidden" name="_D:billLastName" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Street Address:</div></td>
<td colspan="2">
<input maxlength="30" name="billAddressLine1" size="30" type="TEXT" value="340 Main"  readonly=""><input type="hidden" name="_D:billAddressLine1" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Address Line 2:</div></td>
<td colspan="2">
<input maxlength="30" name="billAddressLine2" size="30" type="TEXT" value="Apt 2"  readonly=""><input type="hidden" name="_D:billAddressLine2" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">City:</div></td>
<td colspan="2">
<input maxlength="20" name="billCity" size="20" type="TEXT" value="Agawam"  readonly=""><input type="hidden" name="_D:billCity" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">State:</div></td>
<td colspan="2">
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white" width="100%">
<tbody><tr>
<td>
<input maxlength="2" name="billState" size="2" type="TEXT" value="MA"  readonly=""><input type="hidden" name="_D:billState" value=" ">
</td>
<td  nowrap="">&nbsp;&nbsp;Zip Code:&nbsp;</td>
<td>
<input maxlength="5" name="billZip" size="5" type="TEXT" value="01001"  readonly=""><input type="hidden" name="_D:billZip" value=" ">
</td>
<td width="100%">&nbsp;</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td colspan="3"><div id="TitleBox3" ><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="1" height="1" border="0" bgcolor="white" name="imgTitle"></div>&nbsp;</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Contact Phone:</div></td>
<td colspan="2">
<input onkeyup="return autoTab(this,3,event);" type="TEXT" name="HomeArea" size="3" maxlength="3" value="310"  readonly=""><input type="hidden" name="_D:HomeArea" value=" ">-
<input onkeyup="return autoTab(this,3,event);" type="TEXT" name="HomePrefix" size="3" maxlength="3" value="555"  readonly=""><input type="hidden" name="_D:HomePrefix" value=" ">-
<input type="TEXT" name="HomeSuffix" size="4" maxlength="4" value="1212"  readonly=""><input type="hidden" name="_D:HomeSuffix" value=" ">
</td>
</tr>
<tr>
<td colspan="3"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="5" height="5"></td>
</tr>
<tr>
<td colspan="3"><div id="TitleBox2" ><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="1" height="1" border="0" bgcolor="white" name="imgTitle"></div>&nbsp;</td>
</tr>
<tr>
<td colspan="3" >Payment Information</td>
</tr>
<tr>
<td colspan="3" >
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white" width="100%">
<tbody><tr>
<td >To secure your account, we require all customers to have a valid credit card on file. When it comes time to pay for your order, you will be able to choose to pay with a credit or debit card.<br><br></td>
<td valign="top">
<a href="javascript:vrsn_splash()" tabindex="-1"><img name="seal" border="true" src="https://seal.websecurity.norton.com/getseal?at=0&amp;sealid=1&amp;dn=www.peapod.com&amp;lang=en" oncontextmenu="return false;" alt="Click to Verify - This site has chosen an SSL Certificate to improve Web site security"></a>
</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td colspan="3" >
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white" width="100%">
<tbody><tr>
<td valign="top"><img src="https://www.peapod.com/c/QK/QKLIM.gif" border="0" bgcolor="white" name="verisign"></td>
<td >&nbsp;</td>
<td >We use SSL encryption to protect your personal information, including your credit card information.<br></td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td>&nbsp;</td>
<td colspan="2">
<img src="https://www.peapod.com/c/9H/9HKB3.gif" border="0">&nbsp;&nbsp;
<img src="https://www.peapod.com/c/3O/3OQII.gif" border="0">&nbsp;&nbsp;
<img src="https://www.peapod.com/c/T1/T1YKZ.gif" border="0">&nbsp;&nbsp;
<img src="https://www.peapod.com/c/IG/IGCQH.gif" border="0">&nbsp;&nbsp;
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Card Type:</div></td>
<td colspan="2">
<select  name="/peapod/handler/iditarod/CheckoutRegistrationHandler.creditCardType">
<option value="" selected="">-- Select Type --</option>
<option value="AMEX">American Express</option>
<option value="DISC">Discover</option>
<option value="MC">MasterCard</option>
<option value="VISA">Visa</option>
</select><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.creditCardType" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Card Number:</div></td>
<td colspan="2">
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white" width="100%">
<tbody><tr>
<td nowrap=""><input maxlength="16" name="cardNum" id="creditCardNumber" size="24" type="TEXT" value=""  onfocus="return !showInfoBoxII('cardNumberHelp', event, 1 );"><input type="hidden" name="_D:cardNum" value=" "></td>
<td>&nbsp;<a href="#" tabindex="-1"  onclick="return !showInfoBoxII('cardNumberHelp', event);"><img src="https://www.peapod.com/c/C5/C5NC5.gif" width="21" height="21" border="0" alt="Help on entering your credit card number"></a>
<input id="ccNum" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.ccNum"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.ccNum" value=" ">
<input id="cvv" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.cvv"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.cvv" value=" ">
<input id="key" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.key"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.key" value=" ">
<input id="drCcNum" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.drCcNum"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.drCcNum" value=" ">
<input id="drCvv" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.drCvv"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.drCvv" value=" ">
<input id="drKey" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.drKey"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.drKey" value=" ">
<input id="cvvLength" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.cvvLength"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.cvvLength" value=" ">
<input id="errorCode" type="HIDDEN" value="" name="/peapod/handler/iditarod/CheckoutRegistrationHandler.errorCode"><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.errorCode" value=" ">
</td>
<td width="100%">&nbsp;</td>
</tr>
</tbody></table>
</td>
</tr>
<!-- card id number -->
<tr>
<td align="RIGHT"  nowrap="">Security Code:</td>
<td align="left">
<table cellspacing="0" cellpadding="0">
<tbody><tr>
<td align="left"><input maxlength="4" name="cid" id="creditCardCid" size="4" type="TEXT" value=""  onfocus="return !showInfoBoxII('CardIdNumberHelp', event, 1 );"><input type="hidden" name="_D:cid" value=" ">&nbsp;<a href="#" tabindex="-1" class="popupLink" onclick="return !showInfoBoxII('CardIdNumberHelp', event);"><img src="https://www.peapod.com/c/C5/C5NC5.gif" title="Help on entering your Security Code" width="21" height="21" border="0"></a></td>
<!-- red arrow looks bad &nbsp;&nbsp;<img src="bean:Image.URL[11405]" border=0></td> -->
</tr>
<!-- displayed at top
<tr>
<td align="left" >
<droplet bean="Switch">
<param name="value" value="bean:CheckoutRegistrationHandler.propertyExceptions.missingInfo.errorCode">
<oparam name="MissingCID">
<font color="red">Missing Security Code</font>
</oparam>
<oparam name="InvalidCID">
<font color="red">Invalid Security Code</font>
</oparam>
</droplet>
</td>
</tr> -->
</tbody></table>
</td>
</tr>
<!-- card id number -->
<tr>
<td  nowrap=""><div align="right">Expiration Date:</div></td>
<td colspan="2">
<select  name="/peapod/handler/iditarod/CheckoutRegistrationHandler.expirationMonth">
<option value="0"></option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.expirationMonth" value=" ">
/
<select  name="/peapod/handler/iditarod/CheckoutRegistrationHandler.expirationYear">
<option value="0"></option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
</select><input type="hidden" name="_D:/peapod/handler/iditarod/CheckoutRegistrationHandler.expirationYear" value=" ">
</td>
</tr>
<tr>
<td  nowrap=""><div align="right">Name on Card:</div></td>
<td colspan="2">
<table border="0" cellpadding="0" cellspacing="0" bgcolor="white" width="100%">
<tbody><tr><td nowrap="">
<input  maxlength="20" name="cardName" size="20" type="TEXT" value="Shorty Nge" onfocus="return !showInfoBoxII('cardNameHelp', event, 1 );"><input type="hidden" name="_D:cardName" value=" ">
</td>
<!--
<valueof bean="CheckoutRegistrationHandler.billFirstName"></valueof> <valueof bean="CheckoutRegistrationHandler.billMiddleInitial"></valueof> <valueof bean="CheckoutRegistrationHandler.billLastName"></valueof></td>
-->
<td align="right">&nbsp;<a href="#" tabindex="-1"  onclick="return !showInfoBoxII('cardNameHelp', event);"><img src="https://www.peapod.com/c/C5/C5NC5.gif" width="21" height="21" border="0" title="Help on entering the name on your credit card"></a></td>
<td width="100%">&nbsp;</td>
</tr>
</tbody></table>
</td>
</tr>
<tr>
<td colspan="3"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="5" height="5"></td>
</tr>
<tr>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
</tbody></table>
</td>
<td width="15" valign="top"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="15" height="15"></td>
<td valign="top">
<table width="194" border="0" align="center" cellpadding="0" cellspacing="0">
<tbody><tr><td></td></tr>
<tr><td valign="top"></td></tr>
</tbody></table>
</td>
<td width="15" valign="top"><img src="https://www.peapod.com/c/2Z/2ZAEE.gif" width="15" height="15"></td>
</tr>
<tr><td colspan="5" width="100%">
<div align="center"><input type="image" src="https://www.peapod.com/c/BY/BYKGM.gif" border="0" width="103" height="29" name="submitButton1" align="middle" title="Continue" onclick="return submitMonitor(2);"><input type="hidden" name="_D:submitButton1" value=" "></div>
</td></tr>
</tbody></table>
</td>
<td valign="top" background="https://www.peapod.com/c/AA/AANXG.gif"><img src="https://www.peapod.com/c/AA/AANXG.gif" width="11" height="61"></td>
</tr>
<tr>
<td width="11" height="13" valign="top"><img src="https://www.peapod.com/c/EX/EXMRJ.gif" width="11" height="13"></td>
<td height="13" valign="top"><img src="https://www.peapod.com/c/QT/QTRSM.gif" width="691" height="13"></td>
<td width="11" height="13" valign="top"><img src="https://www.peapod.com/c/4C/4CL8H.gif" width="11" height="13"></td>
</tr>
</tbody></table>
</td></tr>
</tbody></table>
</td></tr>
</tbody></table>
</form>


